Post on 31-Jan-2022
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 1 PCP Overview
Beacon Health Options Primary Care Provider Training
REFERRAL AND RESOURCE GUIDE
Updated October 2015
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 2 PCP Overview
Agenda
1. Review Medi-Cal Managed Care Mental Health Benefits for Mild to Moderate Impairments
2. Referring Members to Beacon Network for Therapy or Medication Management
3. Referring Members Under 21 with Autism Spectrum Disorder for Behavioral Health Treatment/ABA Services
4. Requesting Primary Care Provider (PCP) Decision Support from a Beacon
Psychiatrist
5. Requesting Behavioral Health Care Coordination Support for Members
6. Requesting Authorization for Psychological & Neuropsychological Testing
7. Beacon’s Online PCP Toolkit
8. Summary + Contact Information for Referrals
9. Submitting Grievances on Behalf of Members
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 3 PCP Overview
New Medi-Cal Managed Care Mental Health Benefits
• Individual and group mental health treatment (psychotherapy)
• Psychological testing to evaluate a mental health condition
• Outpatient services to monitor drug therapy
• Psychiatric consultation
• Outpatient laboratory, supplies and supplements
• Screening, Brief Intervention, and Referral to Treatment (SBIRT)
• Prescription drugs carved into Medi-Cal Managed Care Plan
Managed by
Beacon
Managed by Medi-Cal
Managed Care Plan
• New CA Medi-Cal Managed Care Plan outpatient mental health benefits starting January 1, 2014
• Target population: Medi-Cal beneficiaries with a DSM diagnosis and “mild to
moderate” impairment in mental, emotional or behavioral functioning
• The state’s intent is that these therapeutic services are time-limited and solution-focused with the goal of returning patients to primary care management when clinically appropriate
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 4 PCP Overview
Review: Medi-Cal Managed Care Mental Health Benefits for Mild to Moderate Impairments
Medi-Cal Managed Care Plan County Funded & Provided Mental
Health Services
County-funded
Substance Use
Disorder Services Maternity and newborn
care
Pediatric services, including
oral and vision care
Ambulatory patient
services
Prescription drugs (carved
in)
Laboratory services Preventive and wellness
services and chronic
disease management
Mental health services for
Mild to Moderate
Impairments
Medication
management
Individual and group
therapy Psychological testing
Behavioral health
treatment for ASD
Medication
management
Assessment and
treatment planning
Individual and group
therapy
Crisis intervention
Crisis stabilization
Adult crisis residential services
Targeted case
management
Adult residential
treatment services
Full service partnerships
Acute Psychiatric
Hospital Services
Inpatient Professional
Services IMD Psychiatric Services
Outpatient Drug Free
Intensive Outpatient
Residential Services for
pregnant women
Narcotic Treatment
Program
Naltrexone
Inpatient Detoxification
Services (Administrative linkage
to County AOD still
being discussed)
Defining the Bright Line Between Mild to Moderate vs Significant Impairments To be eligible for County-Funded Mental Health Services ALL of the following must be true: 1. Diagnosis: Must fall within one or more of the 18 specified diagnostic ranges 2. Impairment. The mental disorder must result in one of the following:
a) Significant impairment or probability of significant deterioration in an important area of life functioning
b) For those under 21, a probability that the patient will not progress developmentally as appropriate, or when specialty mental health services are necessary to ameliorate the patient’s mental illness or condition
3. Intervention: Services must address the impairment, be expected to significantly improve the condition, and the condition would not be responsive to physical health care–based treatment.
Title 9, California Code of Regulations (CCR), Sections 1820.205, 1830.205, and 1830.210
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 5 PCP Overview
Integrated Sites: Using the Screening Form to Determine Level of
Impairment
1. Complete member info or attach a face
sheet/printout from your EMR
2. Check boxes that apply in each list
3. Use algorithm to inform level of care
4. Be specific on what you are requesting & provide relevant member history to prevent need for member rescreening
5. Beacon will follow up with referral source on outcome
Form Purpose:
1. All integrated sites
must screen Medi-
Cal members to ID
appropriate payer
source.
2. Mild to Moderate =
bill Beacon
3. Significant =
bill DHCS directly
4. Please be reminded
to fax the form to
Beacon even if you
intend to keep the
member and treat
them at your level of
care.
Form Completion:
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 6 PCP Overview
PCP Referral Form: An Easy Way to Link Members with Mental
Health Services
Getting the Form: 1. Download a copy from
the Beacon website at
www.beaconhealthstrate
gies.com
2. Get a copy by emailing
MC_SFHP@beaconhs.com
Form Purpose:
• Streamline PCP
referral process on
one form
• Primary Care Provider
= MD, NP, or PA
1. Complete member info or attach a face sheet/printout from your EMR
2. Select ONE referral reason per form: • PCP decision support • Referral for OP BH
services
• Referral for BHT/ABA • Referral for Care
Management
3. Provide basic background info on the members. **Medications and suspected diagnosis are important to streamline decision support with psychiatrist.
Form Completion:
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 7 PCP Overview
Referring Members to Beacon’s network for therapy or medication management when needs are outside the PCP’s Scope of Practice
PCP Referral Options:
1. Complete the PCP Referral Form and fax to 866-422-3413 or send via secure email to
medi-calreferral@beaconhs.com.
OR
2. Call, or have the member call, Beacon at (855) 371-8117 during routine business hours (M-F
8:30 am - 5 pm).
A. Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting a referral for mental
health services for my patient.”
B. If the patient is not with you at the time to provide verbal consent to release information, Beacon requires
written consent to share information about a member’s mental health utilization and to close the loop
after a referral is completed.
Beacon’s Internal Steps:
• Beacon will contact the member to connect them to services at the appropriate level of care.
• Beacon will contact the source of the referral to confirm completion of referral process.
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 8 PCP Overview
Referring Members with Autism Spectrum Disorder (ASD) Diagnosis for Behavioral Health Treatment/Applied Behavior Analysis
PCP’s Referral Options:
1. For members under age 21, complete the PCP Referral Form and attach a Progress Note indicating an ASD diagnosis and a physician order recommending ABA services. Fax it to 800-596-2712.
OR
2. Call Beacon Service Center at 855-371-8117 during routine business hours (M-F 8:30 am- 5 pm) to make a request.
A. Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting a referral for autism services for my patient.
Beacon’s Internal Steps
• Upon receipt of the referral, a Beacon Autism Services Care Coordinator will contact the member and assist them in securing resources for services
• Beacon will contact the source of the referral to confirm completion of referral process
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 9 PCP Overview
Requesting PCP Decision Support from a Beacon Psychiatrist
1. PCP Decision Support is a telephone call between a Beacon Psychiatrist and a member’s PCP to assist PCPs with diagnostic clarification or prescribing psychiatric medication.
2. Beacon has psychiatrists available M-F to return calls to PCPs. Current Beacon call return hours
are 4 to 5 pm Monday thru Thursday and 2 to 5 pm Friday.
Two Options for Requesting PCP Decision Support
Option 1: PCP completes the PCP Referral Form, along with 2 progress notes + medication list,
and faxes documents to 866-422-3413. Specify your available windows for receiving return calls within timeframes above and best number to call.
A. A Beacon psychiatrist will call the PCP the same day or desired day at requested time.
Option 2: PCP calls Beacon Member Services at (855) 371-8117 requesting to connect with a
Beacon psychiatrist.
A. Press 2 to bypass the phone tree. Say, “I am calling from a PCP office and requesting PCP Decision Support.”
B. You will be transferred to a Beacon clinician (LCSW or LMFT) to complete an internal MD
referral form (to get basic history + medical list). Provide your preferred call back time and number.
C. A Beacon psychiatrist will call the PCP the same day or desired day at requested time.
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 10 PCP Overview
Requesting Behavioral Health Care Coordination for Members
Beacon provides local behavioral health care coordination services from clinical staff who are co-located at the health plan. Examples include:
1) Linking members to a mental health provider
2) Supporting members transitioning between levels of care (e.g. Beacon to County or vice versa)
3) Engaging members with history of non-compliance and/or linking them to community support
services (food, shelter, transportation).
PCP’s Referral Option:
1. Complete the PCP Referral Form indicating member’s openness to receiving support and any requested specific interventions and fax it to (855) 371-8113.
Beacon’s Internal Steps:
1. Beacon Care Manager will triage and attempt to connect with the member within 2 business days of referral date.
2. Beacon Care Manager will keep the PCP/referral source informed of the case and provide updates as needed per member consent to release information.
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 11 PCP Overview
Authorization for Psychological & Neuropsychological Testing
• All psych & neuropsych testing requires prior authorization using a specific Beacon form.
Requests for testing should be made only after a comprehensive clinical evaluation has been
conducted.
• PCPs may refer members for neuropsychological testing. Psychological testing referrals should come from a treating behavioral health provider.
• Psych/neuropsych testing authorization form can be downloaded here: http://bit.ly/1qLJRe9 after completion fax it to 866-422-3413.
• Upon receipt of the referral, Beacon will contact the member and assist them in securing resources for services. Beacon also will notify the referral source to confirm outcome.
Reasons for Psychological Testing Reasons for Neuropsychological Testing
The member usually is receiving mental health services
and the referral comes from a behavioral health
provider to further assess a member’s psychological
functioning or to modify or revise an ongoing
treatment plan. Testing is not authorized as part of an
initial evaluation.
The member usually is not receiving mental health
services. A member who is experiencing cognitive
impairments that interfere with day-to-day functioning
may require neuropsych testing to better define,
localize and quantify the deficits, aid in diagnostic
clarity, and inform appropriate treatment planning.
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 12 PCP Overview
Beacon’s Online Toolkit to Support Primary Care Practices
Toll free
number or
web-based
access to
Beacon
psychiatrists
for diagnostic,
prescription,
or crisis
support
Reference:
Prescription
dosing range
and side
effects
Reference:
Treatment
algorithms
Reference:
DSM
diagnostic
criteria
Reference:
APA
guidelines
Beacon
access
Prescribing
references
Diagnostic
references
Screening
tools
Reference:
PHQ-2/9
Reference:
GAD-7
PCP toolkit components
Reference:
Fact sheets
Reference:
Self-
management
strategies
Member
resources
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 13 PCP Overview
The Toolkit is Accessible Directly From Beacon’s homepage
2
1 Go to beaconhealthstrategies.com
Hover over the Provider tab
3 Click on PCP toolkit
3
2
1
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 14 PCP Overview
Each BH Condition Tab Includes Resources for PCPs and Members
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 15 PCP Overview
Recap: Key Takeaway Points for Primary Care Providers
1. Members with a DSM diagnosis and mild to moderate levels of impairment are managed by Beacon.
Members with significant levels and substance use disorder will be managed by the county mental
health plan.
2. Beacon offers PCPs psychiatric decision support to help with diagnostic clarification and
management of psychiatric medications.
3. Medi-Cal plan enrollees under age 21 with a diagnosis of Autism Spectrum Disorder can be referred
to Beacon for linkage to BHT/ABA services.
4. Beacon offers members behavioral health care coordination support.
5. PCPs have two options to refer members to Beacon for any of these services.
Option 1: Fax a PCP Referral Form
1. Complete form 2. Include clinically relevant
background 3. Fax to 866-422-3413
4. BHT/ABA Fax to 800-596-2712
Option 2: Call (855) 371-8117
1. Press 2 to bypass phone tree 2. Tell customer service representative
you are with a PCP office and specify request
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 16 PCP Overview
Submitting Grievances on Behalf of Members
Per Beacon’s P&P QM 306.01:
1. Members may appoint a representative to act on their behalf with respect to an inquiry,
complaint or grievance by completing a Designation of Grievance Representative Form
2. A member’s designated representative will be granted all the rights of a member with respect to the inquiry, complaint or grievance
3. Possible subjects for grievances include but are not limited to: the quality of care of services provided, attitude and service (i.e. unhelpfulness or rudeness of a provider/office
staff); the quality of a provider’s physical site (i.e. dirty, unsafe, not ADA accessible); and/or Beacon employees or operations.
4. Grievances may include: complaints regarding the timeliness, appropriateness, access to, and/or setting of a provided behavioral health service; or that one of these services did not meet accepted standards for delivery of care.
5. Data generated from the reporting and processing of inquiries, complaints and grievances is used to identify opportunities for improvement in clinical care and administrative services that Beacon’s members and/or providers receive
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 17 PCP Overview
Submitting Grievances on Behalf of Members
Member complaint forms can be directly accessed here:
http://www.beaconhealthstrategies.com/private/pdfs/forms/Member%20Complaint%20Form.pdf
Or they can be accessed on Beacon’s homepage here:
http://www.beaconhealthstrategies.com/index.html
o Click Members < Member Materials
o When prompted, enter SFHP in Plan Name field, select the language, then click Go
As noted on the form, completed Member Complaint Forms should be faxed to Beacon at 1-877-635-4602, or mailed to Ombudsman, Beacon Health Options, 5665 Plaza Drive, Suite 400, Cypress, CA 90630
BEACON HEALTH OPTIONS | beaconhealthoptions.com| November 24, 2015 | 18 PCP Overview
Submitting Grievances on Behalf of Members
1. Acknowledgement letter sent to member within 5 calendar days of receipt
2. Investigation opened
3. Provider letter or Department lead asked for a formal written response to the grievance
4. Resolution letter to member within 30 calendar of receipt of the grievances
5. Grievances are reviewed at Beacon’s monthly Peer Review Committee
6. All potential Quality of Care grievances are reviewed with the Medical Director